• Eli Lilly has outpaced Ozempic-maker Novo Nordisk in the race to develop new incretin drugs.
• The company is set to capture 50% of the $95 billion obesity market by 2050.
• We got a glimpse into Eli Lilly's upcoming menu of metabolic drugs to treat obesity, preserve muscle, and more.

In sports, the best athletes compete against themselves. In the world of weight loss drugs, Eli Lilly is quickly becoming that all-star player that bests the competition every time.

"Lilly is the king. They're the king of the mountain," Deutsche Bank's James Shin, director of biopharma equity research, told Business Insider.

Investors are increasingly buzzing about the world's most valuable healthcare company, the one that they say has left its rivals in the dust.

Danish drugmaker Novo Nordisk, the company that developed Ozempic, initially seemed unbeatable in the new market for injectable diabetes and weight loss medications. But ever since 2022, when Eli Lilly's tirzepatide was first approved for use in the US, Lilly's been steadily gaining ground.

Now, the company is developing a menu of other obesity drugs that could cater to anyone. There's a pill for weight loss instead of an injection. There are drugs that tap into new appetite-regulating hormones; an antibody injection to protect muscles while burning up excess fat.

"Investors are starting to talk about Lilly on their own cue, rather than in the context of Novo," Asad Haider, Goldman Sachs's lead analyst for US pharmaceuticals, told BI. "They are at the forefront of almost every existing as well as emerging mechanism across anti-obesity, and it's going to be really hard, in our view, to leapfrog them."

So, we caught up with Eli Lilly Executive Vice President Ken Custer, the man overseeing it all. Custer is the new president of Lilly's cardiometabolic health division, and in a recent one-on-one with BI, he shared the strategy behind the company's success so far and how they plan to maintain their big lead in the long run.

Eli Lilly is set to dominate the market by 2030

Eli Lilly's tirzepatide, the drug currently leading the charge, is the strongest weight loss drug available so far. While Novo's Wegovy supercharges one of our hunger hormones (GLP-1), Lilly's Mounjaro has two (GLP-1 and GIP), making it a more powerful weekly shot to control appetite and blood sugar.

One recent head-to-head study showed patients who spent a year on tirzepatide lost, on average, about 15% of their body weight, while those on semaglutide (the drug in Ozempic) lost just 8%.

By 2030, Goldman is forecasting, conservatively, that Lilly will capture nearly 50% of the $95 billion anti-obesity medicine market. That forecast includes the injectable drugs we have now, like Mounjaro and Ozempic (for diabetes) plus Wegovy and Zepbound (for obesity) but may also extend to new drugs in the pipeline, both at Eli Lilly and coming from other drugmakers with smaller portfolios. But right now, Lilly seems to be ahead of the competition in just about every category.

In June, at the American Diabetes Association's big annual research conference (ADA), Lilly's updates from ongoing trials were "incrementally better" than investors had expected, Haider said.

"Then on the other side of that, a lot of their late-stage competition — specifically Novo Nordisk, but also Amgen — the updates that you got from them at ADA had a little bit more hair on them, and were frankly met with more disappointment."

1. Speed: 'This ratchet mindset' drives Lilly to develop drugs faster and faster

Eli Lilly CEO Dave Ricks shared some of the secrets behind the big speed up that's shifted the company from an 11-year average time to market (when he first became CEO in 2017) to a six-year average now.

"We really track things very carefully on speed," Ricks said in an interview last October on the "All-In" podcast. "The big idea is like this ratchet mindset that every time we beat a timeline, that becomes the new norm. We just re-benchmark internally."

Case in point: It took about two decades to get Trulicity, Eli Lilly's first GLP-1 drug, on the market. Tirzepatide? About eight years — "blistering speed," Custer said.

2. Convenience: a cheap(er) pill to rival Ozempic

Eli Lilly is in the late stages of developing the first Ozempic-like pill, designed to be just as strong as Novo's injectable drug. The drug, orforglipron, could be available as early as 2026.

There are only about 8 million people currently on Mounjaro, Ozempic, Wegovy, and Zepbound in the US, which speaks to both the high cost of the injectable drugs and the supply bottlenecks.

"The injectable GLP-1s are wonderful medicines, but manufacturing those medicines is hard," Custer said. "The factories that you have to use to do the sterile filling of the vials, the syringes, the devices, the cartridges are extraordinarily hard to build and operate."

Custer believes a daily pill could completely change the game — opening up this new class of hormone-mimicking weight loss and diabetes drugs called incretins to hundreds of millions more people across the globe.

"I think we're at a defining moment in our company's history," Custer said. He added that he sees this as "a generational opportunity that is probably close to what was seen with the early days of vaccines and antibiotics."

Eli Lilly is already manufacturing hundreds of thousands of orforglipron pills, just to make sure it will be able to meet the demand if the drug is approved for use in the US next year. That's a somewhat risky move, considering that the company's final Phase 3 clinical trials that the US Food and Drug administration requires to evaluate the drug aren't even done yet. If approved, orforglipron should also (thankfully) have a more pronounceable brand name.

Expect the cost of the pill to rival a "fancy gym membership," Shin said, meaning maybe around $300 for one month — a quarter of the cost of some injectable weight-loss drugs.

Other companies' attempts to develop a new weight loss pill have been lackluster. Pfizer ditched its obesity pill candidate earlier this year, while Novo Nordisk's pill version of semaglutide, called Rybelsus, is not nearly as effective as Ozempic: Most patients on the pill lose less than 5% of their body weight, while people using the weekly shot can often achieve 10-15% weight loss, or more.

3. Creating a laundry list of new options to get ahead

The north star of Eli Lilly's strategy now is variety — developing a broader range of options for consumers than any of their competitors.

"If you have a billion people around the world or more living with overweight or obesity, they're not all going to be helped by one medicine," Custer said. "We see this segmenting it into several logical categories."

The shift is already underway to find new weight loss options that will harness different hunger hormones (like amylin), use new routes of administration (pills or IVs instead of just injection pens), and have different dosing schedules (daily, weekly, or monthly).

"They're trying to address every type of patient," Shin said.

Here's the menu, beyond orforglipron:

• Bimagrumab: Looking to protect muscle while you lose fat? This is an Eli Lilly drug which may become available after orforglipron, if the mid-stage trials go well in the next couple of years.

  In the most recent trial results, the company shared on bimagrumab at ADA, patients on the drug achieved 100% fat loss, essentially preserving all their muscles. This idea of making sure patients lose the right kind of weight — not compromising their strength just to slim down — is the holy grail in incretin drug development right now, generating tons of buzz and investment.

• Retatrutide: If it's more powerful drugs you're after, then there's the "king kong" triple agonist that the company has been working on. It won't likely be ready to approve until late 2026, at the very earliest, but in clinical trials, it has shown weight loss on par with bariatric surgery, and some patients have lost more than a third of their total body weight, requiring entirely new wardrobes.
• Eloralintide: Finally, there's Lilly's investigational drug that mimics amylin, another metabolism-regulating hormone. It's still early days for eloralintide and for amylin medications in general. So it's possible that competitors like Novo Nordisk or Amgen could develop a compelling amylin drug before Eli Lilly does.

"What's exciting is we feel like we're leading in most, if not all of those categories, but we'll come up with new categories," Custer said. "It is really about tailoring. I think bimagrumab and eloralintide and retatrutide and orforglipron are really the first part of that story, but of course, we have other ideas we're working on as well."

Investors want in on that action. Both Goldman Sachs and Deutsche Bank sent BI disclosure statements for this story, because they each have a financial relationship with Eli Lilly (I challenge you, dear reader, to find a major investment bank that does not).

In the long run, Eli Lilly is thinking ahead to a day when this class of medications could even treat conditions beyond metabolism and heart health, including dementia, inflammation, substance abuse, and pain. (Scientists are starting to study whether incretin drugs might treat migraines, for example).

"It may be even in the future, when you're checking out at Kroger, in addition to the 'get your annual flu vaccine,' you see a sign that says 'get your annual metabolic shot,'" Custer said.

• Michelle Kloese, 42, gained weight from early menopause and a stressful job.
• When she started a new job, she joined a health app paid for through work.
• Walking every day, logging her water intake, and meal swaps helped her lose over 60 pounds.

At 40, Michelle Kloese felt like she didn't recognize her body. In five years, she gained 38 pounds and developed high cholesterol, high blood sugar, and plantar fasciitis, a kind of foot pain caused by inflammation.

She didn't always feel like this. In her 20s, running was her main form of exercise, and she loved 5K races. Her body started to change in her mid-20s, when she experienced symptoms of early menopause, like infertility. By her 30s, bloodwork confirmed she had perimenopause, around 15 years earlier than most women.

Then, in her mid-30s, she started a demanding job as a middle school assistant principal, often starting before the school day and wrapping up after school hours. With less time to work out, a busy schedule, and irregular meals, she started to snack more.

"Somebody would leave a cupcake on my desk, so I'd eat that, or parents would bring in a basket of candy," Kloese, now 42, told Business Insider.

The change in her body really struck her after a surprise trip to Ireland for her 40th birthday. "I looked at the pictures and went, 'Oh gosh, I need to do something different,'" she said.

She had just started a new, less stressful edtech job, Kloese learned about a health app, Personify Health, connected through their insurance. The timing was perfect: she signed up, logging her steps and water intake.

She lost 38 pounds in the first year and 23 pounds the following year. Now she's in a "weight maintenance" phase, seeking to stay within a few pounds of her current weight.

"I have so much more energy — I'm not as sluggish and tired as I was feeling all the time," she said. The issues related to her weight, like high cholesterol and high blood pressure, also went away. "I have just felt a whole lot better."

Kloese shared the three habits she started and still maintains to keep the weight off.

She woke up to a full glass of water

Before, Kloese didn't drink much water — sometimes, she'd only remember to have around eight ounces of the recommended eight cups in one day. "That's one of the most challenging ones for me to do," she said.

Her goal was to get to at least 72 ounces, or nine cups per day.

Tracking her intake helped. The first thing she did every morning was drink a full, 8-ounce glass of water and log it in the app. For the rest of the day, she'd log in "steady sips", using a marked water bottle to measure her progress. It was more manageable for her to track two ounces at a time rather than feel pressure to chug a lot of water at once.

Drinking water helps with weight loss by curbing your appetite. It can also help you reach a calorie deficit if you swap it for high-calorie drinks like soda.

She swapped running for walking and yoga

While she used to run a lot in her 20s, Kloese's knees and hips hurt when she tried in her 40s. She knew she needed to try something different.

When she first made a plan to lose weight, Kloese communicated with a personal trainer through an app. The trainer said that, in her 40s, it was important for Kloese to focus on strength training as we naturally lose muscle with age. Muscle-building can also help with weight loss — gaining muscle boosts your metabolism and burns fat.

Kloese started doing at-home and online circuit workouts 3-4 times a week with light weights.

The rest of the time, she walked. She took part in a fitness challenge of walking 30 minutes a day. Weight-loss-wise, she said she saw about the same results as running.

Now, she aims to walk at least 7,000 steps a day, whether on her walking pad or on trails near her home in Florida. Occasionally, she trains for Mammoth Marches, 20-mile hikes all over the country.

She also swapped out some of the strength training with yoga, which relaxes her while still improving her strength and flexibility.

Being more active transformed her relationships with her friends. "Before, where we might've just picked a restaurant to hang out at, instead, we go out and do a hike," she said.

She made simple meal swaps

Despite snacking on sugary treats at her old job, Kloese isn't much of a sweets person. "I was a pasta-potato-bread kind of person," she said. Still, she wanted to make some more nutritious swaps.

Through the KickStart app, she logged her meals by taking photos of them. If she got a burger and fries, the app suggested lower-carb sides for next time, like a side salad or sweet potato wedges.

Eventually, she naturally made those swaps on her own, like cooking quinoa instead of white rice. She also gets pre-made meals through Factor, which she said helps her with portion control and eating a balanced diet when she's busy.

"Those were all small changes that evolved over time," she said.